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BMJ 2139 European Journal of Hospital Pharmacy EAHP_European Journal of Hospital Pharmacy EAHP 0502013 132 Pae 1
European Journal of
Hospital
Pharmacy
SCIENCE AND PRACTICE
EAHP
SURVEY2010
Hospital Pharmacy Practice in Europe
ejhp.bmj.com
EAHP Survey 2010 on hospital pharmacy
in Europe
Dr. Roberto Frontini, EAHP President
Since 1995, every five years the European Association of Hospital Pharma-
cists (EAHP) has compiled and published a comprehensive survey of hospital
pharmacy practice across Europe. The fourth survey was conducted in 2010,
with data collected until January 2011. It is a pleasure for me to present in
this booklet a summary of the results, which were published in a series in the
EAHP’s official journal, European Journal of Hospital Pharmacy: Science and
Practice (EJHP), in 2012 and 2013.
The survey data are not presented question by question but rather are the-
matically grouped into five chapters that encompass the spread of hospital
pharmacy activity:
1. General frame and staffing;
2. Procurement and distribution;
3. Production and quality assurance;
4. Clinical services and patient safety; and,
5. Education and research
In this way we hope to give a more concise overview without making concessions on the provision of detailed information by coun-
try, by type, and by size of hospital. Where sensible and according to the quality of the data gathered, we also make some compari-
sons to the results of the 2005 and 2000 surveys. Whilst the scale of difference in questions asked in the first EAHP survey (1995) is
too high to allow comparisons with the 2010 data, it is still possible to track the developments in hospital pharmacy practice over
the last decade. This comparability challenge includes the fact that the survey’s reach, in terms of the number of countries covered,
has increased markedly since 2004, particularly in respect to new EU member countries. The published data are the result of some
iteration: after collection of the data the national coordinators scrutinised the results in terms of credibility and in some cases
returned to hospital pharmacies to make corrections to any missing or incomplete data. Some of the final results presented in this
document therefore contain amendments to the preliminary data presented at the EAHP Congresses in 2011 and 2012.
What is the scope of our survey? While we used statistical tools to analyse the data, the results should not be interpreted as ruth-
lessly scientific – rather the survey is a useful ‘snapshot’ of practice. Despite our unique approach of contacting every hospital phar-
macy in Europe, our survey has acknowledged result bias due to differing response rates from different countries and the potential
issues arising from different interpretation of the questions due to language barriers. Nevertheless the scope of the survey is to
give an overview of practice in European hospital pharmacies and this is important for our profession as well as for the EAHP. The
results clearly show gaps in levels of practice between countries and areas of practice where improvement should be an objective.
EAHP sets itself the mission of continuously improving hospital pharmacy practice in Europe for the benefit of patients. The data
collected by the survey supports EAHP in taking decisions on effective actions to achieve this, especially in terms of education and
exchange of experience. However, for every individual hospital pharmacist the survey offers the opportunity to compare practice
in their own country or hospital with that in other European countries. In this respect, the survey results are designed to provide
an effective benchmarking tool for self-directed practice improvement in every European health system. There is no such thing as
perfect practice but there are certainly centres of excellence from which we can all learn.
It is impossible to report all of the survey information in this booklet and we recognise that colleagues may be interested in addi-
tional details. It is for this reason that we have included the original questionnaire in this booklet. A range of information about, and
from, the survey is also available on the EAHP website at www.eahp.eu/publications/surveys. Individuals with further queries are
invited to contact the EAHP office and ask for additional analysis of the responses to a specific question. It should be understood
that due to the complexity and sensitivity of the original data EAHP is not able to make available the primary data.
EAHP has always aimed to create a continuously improving survey. So now, with over 15 years of experience acquired in this project
area, further refinements and modifications to future surveys are planned. These changes will aim to ensure that both the rigour
and the usefulness of the exercise are maintained and built upon. Although still subject to discussion, one suggestion under consi-
deration is for more regular, but shorter, survey activity. This could increase the precision of the survey as a tracking mechanism of
practice improvement and innovation in Europe. In whatever event, as EAHP’s membership and reach continues to extend, and as
information technology opens up new avenues for data collection previously not possible, I am confident that EAHP surveys will
continue to benefit of all those who draw inspiration and conclusions from their findings.
I convey my gratitude to my two EAHP Board colleagues who have led in the compilation of the survey, Tajda Miharija Gala (Slo-
venia) and Juraj Sykora (Slovakia). Without their engagement and intensive communication with the national coordinators, no
reliable data would have been collected and the survey could not have been compiled.
My sincerest gratitude extends to all of the national coordinators who had the challenging task of convincing their colleagues to
take the time and effort to complete the survey and provide the necessary data. Some of these coordinators went further, by pro-
viding translations of the questionnaire and making significant entries of data into the central database. The survey results and this
booklet are the reflection of, and a tribute to, those efforts.
EAHP SURVEY NATIONAL MEMBER COORDINATORS
AUSTRIA Silvia HETZ HUNGARY Gyöngyver SOOS
BELGIUM Raphaël COLLARD IRELAND Joan PEPPARD
Sofie VERBEKE ITALY Ilaria UOMO
BULGARIA Nina PURVANOVA LATVIA Valdis PIRSKO
Ilko GETOV LITHUANIA Birute VARANAVICIENE
BIH Enisa SALIHEFENDIĆ LUXEMBOURG Patrick ENGELHARDT
Tijana MARINKOVIĆ NETHERLANDS Rob MOSS
CROATIA Marijeta DUKARIĆ KURTIĆ Hans OVERDIEK
Ana CRNKOVIĆ NORWAY Frank JØRGENSEN
CZECH REP. Helena ROTTEROVA PORTUGAL Aida BATIST
A
Petr HORAK POLAND Dariusz SMOLINSKI
DENMARK Helle McNULTY SERBIA Dragana RAJINAC
Gitte NIELSEN SLOVAKIA Juraj SYKORA
ESTONIA Tiia VALS SLOVENIA Tajda MIHARIJA GALA
FINLAND Hanna TOLONEN SPAIN María José TAMES
FYROM Maja KOVAČEVA Eduardo ECHARRI
FRANCE André RIEUTORD SWITZERLAND Susanna KUSSMANN
GERMANY Steffen AMANN SWEDEN Per NYDERT
GREECE Despina MAKRIDAKI UK Richard CATELL
EAHP Survey 2010 EAHP Survey 2010
EAHP Survey 2010 on hospital pharmacy in Europe: The majority of hospitals (n=1102) in
Europe are publicly owned (81%). Private
hospitals (10%) and church affiliated
Part 1. General frame and staffing hospitals (4%) are less frequent. Of all
of the hospitals, 79% (n=1168) were
1,2 1,3 1,4,5 general hospitals (teaching=36%, non-
Roberto Frontini, Tajda Miharija-Gala, Juraj Sykora teaching=43%). Hospital pharmacies from
psychiatric (5%), oncology (3%), geriatric
(2%) and ophthalmic hospitals (0.4%) also
In 2010, the European Association of Hospital Pharmacists (EAHP) conducted its fourth survey on hospital pharmacy participated in the study.
practice in Europe. 4748 heads of pharmacy were contacted in all member states through a network of national One hospital pharmacy serves a median
coordinators. 1283 hospital pharmacies from 30 countries answered the questionnaire with an overall response rate of of 410 complete hospitalisation beds in
Europe (n=1139, average 606 beds) and
27.0%. The average number of beds served by one pharmacy had not changed since 2005 but there was a decrease in the distribution was fairly homogeneous
complete and an increase in partial hospitalisation. Pharmacists (27%) and qualified technicians (32%) make up 60% of for hospitals with between 100 and 1500
the total staff. The number of pharmacists/100 beds varies from 0.24 (Bosnia and Herzegovina) to 4.35 (UK). Only a few beds (table 2). From the perspective of total
countries did not experience shortages of pharmacists and technicians. European hospital pharmacy staffing (pharmacists number of beds served, small hospitals (<300
and pharmacy technicians) remains, on average, low compared with the USA and has not grown significantly since 1995. beds) covered only 7.5% and very large ones
Therefore, it can be problematic to make direct comparisons between hospital pharmacy services in the USA and Europe. (>1.500 beds) 35.7% of the total beds.
There were significant differences
between countries in relation to the average
Introduction significant, NC translated the questionnaire of questionnaires sent out in that country, number of beds served by one hospital
The pan European survey on hospital and thus improved the response rate and multiplied by 87 (total number of questions). Figure 1 Contribution (%) of single countries to the total number of responses. Percentages are weighted on pharmacy (only complete hospitalisations,
pharmacy practice is an important source number of correct answers. The total weighted response rate was 16.7%. the basis of answered questions. BiH, Bosnia and Herzegovina; FYROM, Former Yugoslav Republic of Macedonia. figure 2). The largest numbers were in
in understanding the future challenges and The collected data were analysed by Response rates varied substantially Denmark (2974), Germany (1566), the
needs for development in Europe. In 2002, the country (30 European countries), by size of across the member states. The highest UK (1310), Lithuania (1249), Austria
European Association of Hospital Pharmacists the hospital (number of beds—12 groups), by response rate was achieved in FYROM Table 2 Distribution o hospita pharmaies b number o beds sered n 113 (1203) and the Czech Republic (1115).
(EAHP) General Assembly, in Portorozˇ, type of hospital (seven groups) and also in (Former Yugoslav Republic of Macedonia) pe o pharma b o o Comparisons with the survey from 2000
Slovenia, decided to run the survey every comparison with previous EAHP surveys.1 2 were all hospital pharmacies answered the beds sered ompete and o o beds and 2005 (figure 2) showed that in most
5 years. In 1995, 18 countries participated, Where appropriate, we also compared questionnaire (table 1). Very good response partia hospitaisations o o pharmaies o a pharmaies sered in tota o tota beds of the countries there was a trend towards
in 2000, 16 countries, in 2005, 22 countries the results with the American Society rates above 50% were also found in Austria, 1–
15 1.3 5
0.1 increasing the number of beds served, which
and in 2010, 30 countries participated. of Health System Pharmacists (ASHP) Croatia, Estonia, Latvia, Luxembourg, 50– 53
.7 3888 0.5 was probably caused by the closing and
National Survey 2011.3 Slovakia and Slovenia. The poorest response
The 2010 survey was based on a We performed only 100–1 168 1
.7 2
85 3.1 merging of pharmacies.
questionnaire with 87 questions covering descriptive analysis of the data but further rates were in France, Lithuania, Poland and 200–2 12
10. 30
3
3.8 The average number of beds served by
the following major topics: investigation will be performed in the future. the UK. 300–3 138 12.1
7
56 5. a single hospital pharmacy (complete and
1. General frame and staffing Each single question was answered
00–5 18
16.2 062 11.3 partial hospitalisations) increased between
Results by a median of 960 (74.8%) of the 1283 600–7 126 11.1 85
63 10.7 2000 and 2010, from 648 to 708 beds (median
2. Procurement and distribution The average response rate was 27.0% responding pharmacists (minimum 64 800– 73 6.
65706 8.2 2010=427). While complete hospitalisations
3. Production and quality assurance (1283/4748). As not all of the questions (5.0%), maximum 1168 (91.0%)). The 1000–1
137 12.0 166701 20.8 decreased, partial hospitalisations had an
4. Clinical services were answered in the questionnaires, we number of responding pharmacists to a 1500–2000 55
.8 3700 11.7 upward trend, showing a shifting in hospital
5. Patient safety also calculated a weighted response rate, specific question is indicated as n (number) >2000 66 5.8 12
37 2
.0 services to day care.
6. Education and research. which is the ratio between the total number and all results (in %) are related to the n of The major groups of staff in hospital
Methods of answered questions and the total number the single question. The highest total number of responses country to the total n (1283 hospital pharmacies (ie, full time equivalents
A total of 4748 heads of pharmacy were was achieved in Italy (117=39.0% of pharmacies=100%) are displayed in figure 1. (FTE)) were qualified pharmacy assistants/
contacted in all member states through a Table 1 Response rates by ontry pharmacies) and Germany (130=30.8%). Percentages are weighted on the basis of the technicians (PT, 32%), followed by
The contributions of each respective answered questions. pharmacists (27%), non-qualified pharmacy
network of national coordinators. The role Response rate eihted Response rate eihted assistants (14%) and administrative staff
of the national coordinators (NC) was to ontry ontry (8%). Prescriptionists (bachelor of pharmacy)
provide the contact addresses of the heads of stria 8. 71.2 tay 3
.0 30.
are employed in some north European
the hospital pharmacies and then motivate eim 27.0 15.6 atia 75.7 56. countries but play only a minor role (1%).
them to take part in the survey, as well as i 0.0 30.5 ithania 10.
5.8 The average number of
facilitating completion of the questionnaire. aria 30. 23.6 embor 100.0 68.6 pharmacists/100 beds (FTE in
In countries where the language barrier was roatia 81.5 53.8 etherands 2.7 11.2 complete + partial hospitalisations) was
eh 61.2 0.1 oray 56.3 33.
1.1 (median 0.9) but there were large
Repbi
1 enmar 63.6
.2 oand 15.1 6.0 differences across Europe (figure 3).
European Association of Hospital Pharmacy, Brussels,
Belgium stonia
0.0 67.7 orta 1.7 28.6 The country with the highest ratio was
2 inand 33.1 18.8 erbia 56.3 33.5
Universitätsklinikum Leipzig, Leipzig, Germany the UK (4.35) and Bosnia and Herzegovina
3 rane 5.0 1.5 oaia
3.5 7.6
University Medical Centre Ljubljana, Ljubljana, Slovenia had the lowest (0.24). In terms of total
4 R 100.0 72.3 oenia
2.0 67.2
National Cancer Institute, Bratislava, Slovakia staff/100 beds the highest ratio was also
5 ermany 30.8 1
.5 pain 26.8 13.7
Slovak Medical School, Bratislava, Slovakia in the UK (12.59) and the country with
reee 2.2 17.
eden 50.0 33.3 the lowest ratio was Lithuania (1.45). The
Correspondence to nary . 35.7 iterand 57.5 38.
average across Europe was 3.8 (median 3.5).
Dr. Roberto Frontini, Direktor Universitätsklinikum reand 63.6 35. 3.5 8.8
Leipzig – AöR Apotheke Liebigstr. 20, 04103 Leipzig, i osnia and ereoina; R ormer osa Repbi o aedonia. Figure 2 Average number of beds served by one pharmacy by country (n = 1139). BiH, Bosnia and The number of pharmacists and PT
Germany; Roberto.frontini@medizin.uni-leipzig.de Herzegovina; FYROM, Former Yugoslav Republic of Macedonia. (FTE) classified by the number of hospital
European Journal of Hospital Pharmacy 2012;19:385–387. doi:10.1136/ejhpharm-2012-000162 385 386 European Journal of Hospital Pharmacy 2012;19:385–387. doi:10.1136/ejhpharm-2012-000162
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